Despite some of the challenges I have described, USAMRIID remains a critical national asset with amazing scientists and capabilities. USAMRIID continues as a leader developing countermeasures against Ebola and anthrax as well as many other diseases, like tularemia, encephalitis viruses, botulism, ricin, and plague. Work conducted at USAMRIID over decades has built a foundation for countermeasures for many of those diseases. Decades of Ebola studies there on the pathogenesis, pathology, pathophysiology, diagnostics, vaccines, and therapeutics are the reason we had any potential countermeasures to choose from during the 2014–16 West Africa Ebola outbreak. The vital work needs to continue.
If you were to visit Fort Detrick today, you would notice right behind USAMRIID a massive five-story building under construction, the “New” USAMRIID. When it is completed, it will contain the largest BSL-4 lab in the world. It is a hopeful sign, but USAMRIID doesn’t often get the credit it deserves and the army does a poor job of recognizing and championing its “crown jewel” biodefense research facility a stone’s throw from the Washington DC Beltway. This is unfortunate because with recognition comes resources. As Caree Vander Linden told me recently, “We always got beat up for doing the right things,” but somehow we survived. “We’re a resilient organization.” That’s a testimony to the people who have lived and worked there.
As the “old guard” who worked with me transition to retirement or transfer to one of the other containment labs around the country, the biggest challenges may be filling the institute with qualified scientists and paying the massive electricity bill.
A full list of USAMRIID’s contributions to biodefense and science, in general, probably deserves its own book, but USAMRIID has had an incredible safety record for over forty-five years, despite countless employees working on extremely hazardous pathogens. It has also set the standard for things like containment care and aeromedical isolation for patients with highly hazardous communicable pathogens, which have now been replicated elsewhere. Probably its most important asset is the people who have worked there over the decades. They have made significant impact with their work at USAMRIID and also after moving to other containment laboratories across the nation at the NIAID, the CDC, and the University of Texas; to academia; and to the pharmaceutical industry. USAMRIID personnel have shared their expertise in containment lab safety and bioweapon inspections, produced educational materials on biowarfare and bioterrorism, provided diagnostic support for outbreaks, and developed vaccine protocols and products for outbreak response.
Whenever a new infectious disease crisis occurs, USAMRIID answers the call from the nation and the world, sometimes in the lead, sometimes in a supportive role. My hope is that USAMRIID remains the cornerstone for biodefense that will serve us well into the future, but it will take ongoing nourishment and support from the army. When the next emerging infectious disease or bioterrorism crisis occurs, the nation should continue to expect USAMRIID investigators to remain the nation’s “Biohazard 911”—a response hotline, willing to drop everything to respond again to the nation’s needs.
As for me, I joined the army in 1985 inspired to become Hawkeye Pierce from M*A*S*H, but as I left in 2016, my friends more rightly compared me with the Dustin Hoffman character from the movie Outbreak. Physicians in the army are taught that they are soldiers and officers first and physicians second. When I was a new division chief at USAMRIID, one of our commanding generals recited “I Am a Soldier” at a retreat with all his subordinate commanders. When the subordinate commanders took the stage, each began his or her remarks with the words “I am a soldier.” It didn’t resonate with me at the time; however, now that I am retired from the army, as I look back on my career, I realize how important it has been for me, and how proud I am, to be a soldier. It is truly in my blood.
I arrived at USAMRIID as a junior physician-officer wanting to do something important. My experiences reached far beyond my expectations, and I am grateful that my bosses, commanders, and generals along the way had the confidence to give me opportunities to lead, which gave me a seat at the table for some of the most exciting infectious-disease challenges of this generation. I left USAMRIID in 2009 with more gray hair and the scars of managing crises, but I wouldn’t trade my experiences there. Some crises were real, others were false alarms, but we couldn’t distinguish between the two as they began. Sometimes our preparations succeeded, other times not. But each time we came together, assessed the situation, and developed a response plan that worked.
I hope that my stories have given the reader a sense of the challenges and opportunities of working in this field and the numerous individuals who have dedicated their work and lives to this mission. I tried to give some of them a voice here, especially as they related to frustrations in the aftermath of the anthrax investigation. They are unsung government heroes dealing the best they can with difficult circumstances. The excitement I have had in my career was all about working with these friends and colleagues, our focus on the mission, and overcoming the shared challenges and frustrations together to make things better. Perhaps I am naive, but I hope that my stories inspire a new generation to work at one of the military’s research labs or enter the fields of biodefense and infectious diseases. For me it has been quite an adventure.
I like to think I made a difference in the nation’s preparedness for and response to biothreats and emerging infectious diseases. Although my career focused on those issues, at my core I am a physician who cares about people. Ultimately, I hope the beneficiaries of anything I have done are the patients—the soldiers, sailors, air force personnel, marines, and DoD civilians who willingly leave the protected confines of the outer perimeter in a hostile environment, trusting that we will use the best tools at hand to protect them and care for them when they become ill or are injured. We need to continue the scientific discoveries to protect them against the next biological weapon threat—and possibly against Mother Nature.
I spent my final tour in the military at “America’s Medical School” at the Uniformed Services University of the Health Sciences (USU), where I ran an international infectious-disease research network and later became the associate dean for research. I transitioned out of the army in 2016, after twenty-seven-plus years, but I continue to collaborate with USAMRIID and USU colleagues, studying Ebola and training the next generation of military medical providers on biodefense. Through my current faculty position at the University of Nebraska’s Medical Center and College of Public Health, where I work with a great group of colleagues at the National Ebola Training and Education Center (NETEC), I teach about infection control for disease outbreaks, conduct hospital preparedness consultations, and am helping to build a special pathogens research network. The vision we espoused in our article about biocontainment units has come to fruition. Through the work of the NETEC, the United States now has a hospital network with one designated biocontainment facility in each of ten emergency-response regions of the country. The focus of the network has expanded from Ebola to emerging infections. We don’t know what the next infectious disease crisis will be, but it is guaranteed that it will be different from what we predict. Therefore, having a national platform for response and research is critical.
As I finish this book, a new Ebola outbreak that started in August 2018 is raging in the Democratic Republic of the Congo (DRC) with no end in sight. Sadly, despite having new tools (investigational vaccines and treatments) at our disposal, human nature continues to fuel the outbreak, which recently passed three thousand victims. Suspicion of the response teams on top of decades of civil strife have created the “perfect storm,” where the responders and Ebola treatment units are being targeted directly in violent attacks, making this outbreak perhaps the most complex and challenging ever to control. I had the honor of leading Ebola infection control efforts for six weeks (December 2018–January 2019) for WHO in Burundi to prepare for a possible spillover from the neighboring DRC. This experience allowed me to make up for missing the chance to help out on the ground during the West Africa outbreak. Driving the mud-covered and pot-holed roads, visiting hospital wards, evaluating the Ebola treatment unit, and working with the local hospital, WHO, and ministry of health staff, I applied the different layers of skills that I had developed over decades for a very practical field mission. It was perhaps the most challenging and exhilarating work I have ever done.
Although I am technically “retired” from the military, my adventures continue. The work is too fascinating, and the opportunities, needs, and questions infinite, so it is hard to quit once you’ve caught the bug.